{% extends "agmstaff/index.html" %}
{% block title %}英宝玩具-{{ keyword }}提交{% endblock %}
{% block title0 %}英宝玩具-{{ keyword }}提交{% endblock %}
{% block page_bd %}
        <form method="POST">
        <div class="weui-cells weui-cells_form">
            <div class="weui-cell">
                <div class="weui-cell__hd"><label class="weui-label">{{ keyword }}人</label></div>
                <div class="weui-cell__bd">
                    <label class="weui-label">{{ name }}</label>
                </div>
            </div>
            <div class="weui-cell weui-cell_form">
                <div class="weui-cell__hd">
                    <label class="weui-label">联系电话</label>
                </div>
                <div class="weui-cell__bd">
                    <input class="weui-input" type="tel" name="phone" pattern="[0-9]*" placeholder="请输入联系电话">
                </div>
            </div>
        </div>
        <div class="weui-cells">
            <div class="weui-cell weui-cell_select weui-cell_select-after">
                <div class="weui-cell__hd">
                    <label for="" class="weui-label">被{{ keyword }}内容</label>
                </div>
                <div class="weui-cell__bd">
                    <select class="weui-select" name="report_type">
                        <option>人</option>
                        <option>事件</option>
                        <option>物品</option>
                        <option>其它</option>
                    </select>
                </div>
            </div>
        </div>
        <div class="weui-cells__title">具体描述</div>
        <div class="weui-cells weui-cells_form">
            <div class="weui-cell">
                <div class="weui-cell__bd">
                    <textarea class="weui-textarea" name="des" placeholder="请输入具体描述" rows="3"></textarea>
                </div>
            </div>
        </div>
        <div class="weui-btn-area">
            <a class="weui-btn weui-btn_primary" id="submitBtn" href="javascript:">确定提交</a>
            <a class="weui-btn weui-btn_default" href=".">返回主页</a>
        </div>
        </form>
{% endblock %}
